The socioeconomic burden of pediatric tuberculosis and role of child-sensitive social protection.

BACKGROUND: Households of children with tuberculosis (TB) experience financial and social hardships, but TB-specific social protection initiatives primarily focus on adults. METHODS: We conducted a single-arm, pilot study of multi-component supportive benefits for children with pulmonary TB in Kampala, Uganda. At diagnosis, participants received in-kind coverage of direct medical costs, a cash transfer, and patient navigation. Caregivers were surveyed before diagnosis and 2 months into TB treatment on social and financial challenges related to their child's illness, including estimated costs, loss of income and dissaving practices. RESULTS: We included 368 children from 321 households. Pre-diagnosis, 80.1% of caregivers reported that their child's illness negatively impacted household finances, 44.1% of caregivers missed work, and 24% engaged in dissaving practices. Catastrophic costs (> 20% annual income) were experienced by 18.4% (95% CI 13.7-24.0) of households. School disruption was common (25.6%), and 28% of caregivers were concerned their child was falling behind in development. Two months post-diagnosis, 12 households (4.8%) reported being negatively affected by their child's TB disease (difference -75.2%, 95% CI -81.2 to -69.2, p < 0.001), with limited ongoing loss of income (1.6%) or dissavings practices (0.8%). Catastrophic costs occurred in one household (0.4%) at 2 months post-diagnosis. CONCLUSIONS: Households face financial and social challenges prior to a child's TB diagnosis, and child-sensitive social protection support may mitigate ongoing burden.

Observed restrictive feeding practices among low-income mothers of pre-adolescents.

OBJECTIVES: To describe verbal and non-verbal restrictive feeding practices used by low-income mothers with their pre-adolescent children during a laboratory-based protocol, and examine associations between mother/child anthropometrics, child appetitive traits and mothers' restrictive practices. METHODS: Mothers and children (dyad n = 108, mean child age = 11.0 years [SD = 1.2]) were provided a standardized meal and then buffet of desserts. Sessions were video-recorded, and trained coders reliably identified positive and negative restrictive statements, non-verbal restrictive behaviours and redirection to healthier foods. Mother/child anthropometrics were measured by trained study staff and child appetitive traits reported by mothers using subscales of the Children's Eating Behaviours Questionnaire. Negative binomial regression was used to examine associations between mother/child characteristics and restrictive practices. RESULTS: Nearly all mothers (89.8%) engaged in restrictive feeding during the dessert buffet. Positive restrictive statements were the most common form of restriction (mean statements/10 minutes = 3.2 [SD = 3.1]). No associations were observed between children's body mass index (BMI) or appetitive traits and mothers' restrictive feeding practices. Associations of small effect size were observed between mothers' BMI, use of positive restrictive statements (incidence rate ratio [IRR] = 0.98 [0.96-0.996]) and non-verbal restrictive behaviours (IRR = 0.96 [0.93-0.99]). CONCLUSIONS: Laboratory-based feeding protocols can objectively assess nuances in restrictive feeding practices. Further research is needed to understand how specific approaches to restriction affect children's eating behaviours and weight.

Social Exclusion Shifts Personal Network Scope.

Social exclusion has the potential to alter subsequent social interactions with the members of personal networks, especially given their online availability in contemporary life. Nonetheless, there is minimal research examining how social challenges such as exclusion alter ensuing interactions with personal ties. Here, we tested whether being excluded during a social interaction changed which relationships are most salient in an ostensibly unrelated, online news sharing task. Across three operationalizations of tie strength, exclusion (vs. inclusion) increased sharing to close friends, but (unexpectedly) decreased sharing to close family members. The findings provide preliminary evidence that negative encounters may shift attention toward certain types of network ties and away from others. Future work is needed to examine how social experiences influence personal network scope - i.e., who comes to mind - in the background of daily life.